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2 COMPREHENSIVE EVALUATION OF A SOCCER PLAYER Oluseun A. Olufade, MD 4/22/16

3 OUTLINE Epidemiology Injury prevention Hamstring FIFA 11+ Athletic development program Sports science

4 BORN TO PLAY SOCCER

5 SECRET TO BEING A SUCCESSFUL SOCCER PLAYER? Technical Physical Tactical Psychology

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9 ITINERARY Monday, January United States U 17 MNT vs. Romania Tuesday, January 12pm United States U 17 MNT vs. Greece Thursday, January 21@ 2:30pm United States U 17 MNT vs. Belgium Saturday, January TBD United States U 17 MNT vs TBD (Placement match)

10 Average: 7-8 miles, change directions 1,000 times and intermittent sprints every 90 seconds High: 130 mins, 10.5 miles, 65 sprints of 10 yards or greater, 2500 calories

11 Performance is about energy Without energy, there is fatigue Goals, fouls and injuries increases as games proceed

12 92% OF ALL MUSCLE INJURIES AFFECT THE 4 BIG MUSCLE GROUPS Rank Diagnosis % of all injuries RTP Mean (SD) RTP Median Re-injury % 1 Hamstring muscle injury (15) Adductor muscle injury 9 14 (22) Quadriceps muscle injury 5 19 (20) Calf muscle injury 4 17 (15) 13 11

13 LIGAMENT INJURIES Rank Diagnosis % of all injuries 3 Ankle sprain, lateral ligament RTP Mean (SD) RTP (Median) 6 21 (21) Knee MCL tear 4 24 (25) Ankle sprain, medial ligament 1 14 (16) ACL tear (74) Knee LCL tear (24) Re-injury

14 SEVERE INJURIES (ABSENCE >28 DAYS) Ran k Diagnosis % of all injuries RTP Mean (SD) RTP Median 26 ACL tear (74) Lateral meniscus rupture (53) Syndesmotic rupture (29) Sports hernia (30) Metatarsal fracture (34) Medial meniscus rupture (41) 37 2 Reinjury

15 OVERUSE INJURY Rank Diagnosis % of all injuries RTP Mean (SD) RTP Median 11 Knee synovitis 2 13 (24) Achilles tendinopathy 2 25 (28) Patella tendinopathy 1 20 (37) Ankle synovitis 1 15 (40) 6 30 Reinjury % - Uncommon - Short RTP - High re-injury rates

16 CLASSIFICATION SYSTEM Defined clinical entities for groin pain Adductor related Iliopsoas related Inguinal related Pubic related Hip-related groin pain Other courses of groin pain in athletes

17 HIP ADDUCTOR MUSCLE STRENGTH IS REDUCED PROCEDING AND DURING THE ONSET OF GOIN PAIN IN ELITE JUNIOR AUSTRALIAN FOOOTBALLL PLAYERS 86 players (16-18) Weekly strength Weekly check groin pain Normal variation 2-3% 2 wks pain = start injury

18 12 % decrease strength before pain onset

19 UEFA GROIN STUDY (BJSM 2009) Time loss injury 7/team/year ¼ acute, ¾ overuse 2/3 adductor-related Recurrence = 2 months

20 FIFA 11+ Lower extremity: 69% Foot: 31% Knee: 26% Ankle: 21% Upper extremity: 28 % Wrist: 29% Hand: 26% Head, spine & thorax: 3%

21 Traumatic: 70% ACL Overuse/Growth related: 29% Osgood Schlatter

22 FIFA 11+ Created in 2005 On field dynamic warm up physiology & prevention Attempt to decreased trunk, hip, knee and ankle soccer related injury

23 FIFA 11+ Rate of serious injuries 27% compared to >13 years Proportion of fracture (40%) and UE injuries (28%) Mechanism of injury mostly due to high intensity biomechanical load MORE WINS, FEWER LOSSES IN FIFA 11+ TEAMS

24 HAMSTRING INJURIES 13-18% from a previous identical injury within 2 months of RTP Sprinting type 70-80% Askling H test L-protocol

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27 L-PROTOCOL VS. C-PROTOCOL ASKLING 2014 L protocol: 49 days C protocol: 86 days Proximal free tendon took significantly longer time to heal 2 C protocol re-injury

28 MANUAL OR EXERCISE THERAPY ADGP RCT: Exercise vs. Multimodal 2.5 years follow up Outcome: no pain with resistance no groin pain during and after soccer RTP previous level

29 CROW ET AL 86 players (16-18) Weekly strength Weekly check groin pain 2 wks pain = start injury 12% decreased strength before pain onset

30 ATHLETIC DEVELOPMENT PROGRAM ADP Gymnastics Coordination Core strength Mobility Confidence Focus

31 ADP Multi-dimensional Speed and Agility Running/Sprinting technique Deceleration technique Change in Direction Coordination

32 ADP Strength based warm up Resistance training Body weights Total body emphasis

33 SPORTS SCIENCE Biomechanics Physiology Psychology Medicine Nutrition

34 PERFORMANCE Knowing analysis and recovery process Individual player performance indicator Marker of fatigue

35 NUTRITION Its effect on performance, macronutrient as fuel and individual needs of athlete P:I:T:C:H

36 Souglis AG, Chryssanthopoulos C, Travlos AK, Zorzou AE, Gissis I, Papadopoulos C, Sotiropoulos A (2012) The effect of high vs. low carbohydrate diets on distances covered in soccer, Journal of Strength and Conditioning Research, doi: /JSC.0b013e

37 HEART RATE MONITORING Aerobic measurement More reliable, expensive, require expert analysis and time consuming interpretation Provide information for monitoring, facilitating a more efficient planning and manipulation of players internal training load

38 POLAR TEAM 2 SYSTEM Very Light (grey; 50-59%) Light (blue; 60-69%) Moderate (green; 70-79%) Hard (orange; 80-89%) Maximum (red; %)

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40 GPS More accurate compared to video recording estimate technique Provide analysis of physical effort, movement pattern and technical action Comparing performance

41 QUANTITATIVE MOVEMENT DEMANDS Determine basic pattern of movement to improve athletes conditioning and performance Velocity Compare regular season to final matches (Aughey 2011) 9% increase in high intensity running 11% increase in total distance 97% increase in number of maximal acceleration

42 TRAINING AND COMPETITION DIFFERENCES Player position AFL, nomadic players covered 3.5% for distance, 17% higher exertion index and 23% more time running compared to forward and defenders Relationship between fitness and athletic performance SSG vs. GT, 29.4 s more in aerobic and higher Vo2max during soccer training

43 Aerobic threshold: the intensity of exercise at which anaerobic glycolytic energy pathway starts to be a significant part of the energy production: 2mM Anaerobic threshold: intensity of exercise at which lactate builds up in the blood faster than it can be cleared: 4mM

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45 REFERENCES OF LACTATE THRESHOLD Player N Age Yrs Professional male player Professional female player Recreational male footballers Injured male footballers HR T2 bpm HRT2 %HR max T2 Speed km/h HR T4 Bpm HRT4 %HR max T4 Speed Km/h

46 CONCLUSION The rate and types of soccer injuries are different when compared to other type of sport Specific injury prevention and training are required to minimize time lost Sports science presents an exciting future to the soccer medicine